It is time for parents, pediatricians and policymakers to prevent children from breathing secondhand smoke, says a statement issued Monday by the American Heart Association.

Despite dramatic decreases in smoking rates in recent decades, secondhand smoke exposure is a prevailing health problem, said Geetha Raghuveer, M.D., chair of the statement’s writing panel and a professor of pediatrics at Children’s Mercy Hospital and Clinics in Kansas City, Missouri.

Children exposed to secondhand smoke can have early stiffening and narrowing of the arteries that can lead to premature cardiovascular disease, the statement said. Some of these children also face a host of other possible risk factors for heart disease, such as obesity, high cholesterol, high blood pressure and insulin resistance — a precursor to diabetes.

“We already knew the respiratory and carcinogenic effects of secondhand tobacco smoke in kids, so this statement just adds fuel to the fire for a zero tolerance policy,” said pulmonary specialist John Balmes, M.D., a professor of medicine at the University of California, San Francisco, who was not involved in writing the statement.

Secondhand smoke causes “the same type of effects as active smoking or air pollution exposure,” said Balmes, also a professor of public health at UC Berkeley. “Inflammation in the airway and lungs spills over into the circulation and affects arterial function.”

Sidestream smoke, the smoke that is emitted from the end of a burning cigarette, is just as toxic as mainstream smoke, the smoke that is inhaled by the cigarette smoker, Raghuveer said.

Two out of five children ages 3 to 11 and one out of three kids ages 12 to 19 are exposed to secondhand smoke, according to 2011-2012 data from the Centers for Disease Control and Prevention. Exposure is much more common for black children ages 3 to 11: 68 percent, compared with 37 percent for whites and 30 percent for Mexican Americans.

Children who live with a smoker will almost certainly be exposed to secondhand smoke at home or in a car or, the statement said.

“It’s particularly bad for parents to smoke with a kid in the car,” and rolling down the windows doesn’t help, Balmer said.

In addition to parents, exposure could be from babysitters, grandparents, aunts, uncles and friends, he said.

“Children, especially young children, are invariably exposed involuntarily,” Raghuveer said. “As the kids get older, there’s more exposure outside the home” such as traveling with smokers or being among smokers at a friend’s house, she said.

Research suggests secondhand smoke exposure is higher among people who rent housing compared to those who own their homes. Smoke can permeate the apartments of nonsmokers from apartments of smokers or from common areas.

Under a plan proposed by the U.S. Department of Housing and Urban Development in 2015, public housing nationwide would be smoke-free. The rule has not yet been finalized. Some housing authorities, however, have already implemented voluntary smoke-free policies.

Communities nationwide are also stepping up. As of July 2016, nearly 60 percent of Americans live in states or cities with smoke-free laws for workplaces, restaurants and bars, according to data from the American Nonsmokers’ Rights Foundation.

Pediatricians also have a role. To reduce the number of children exposed to secondhand smoke, pediatricians should screen for it and educate parents about the dangers of secondhand smoke exposure at every opportunity, Raghuveer said. In addition, policies that prohibit smoking in public places and taxes on cigarettes don’t directly affect kids but can help reduce secondhand smoke, she said.

“Smoking is bad for [parents] and for the kids around them,” Raghuveer said. “It’s bad, period.”

[…] American Heart Association (AHA) says that kids exposed to secondhand smoke may be more prone to cardiovascular issues decades down the road. This means secondhand smoke can affect them years after they’ve left the smoky confines of […]